Registration
Special 4 hr. event includes free-play in gym including trampolines and inflatable Kiddiepillar. Pizza and fresh veggie or fruit. Cost per child: $45 for non-enrolled, $40 for enrolled. Sibling discounts applied. Ages 4 - 12
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Please tell us how you heard about Energy.*
Does you child have any food allergies?*
Does your child have any medical conditions of which the staff should be aware?*
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*